Introduction

The Central Norfolk Health and Social Care Economy – or Central Norfolk NHS– is made up of seven local health and social care organizations (see Exhibit 4.8). The main focus since 2003 has been a long-term Performance Improvement and Transformation Programme designed to revolutionize the way healthcare is delivered in the region, based on local diagnosis and better home-based care.

Exhibit 4.8: Better Care for Norfolk: Key Partners in the CNHSCE

The senior executive brought in from outside the region to oversee the Programme, Phyllis Shelton, together with the Economy's chief executives, set a high bar for success. But they recognized that in doing so, the new collective would have a long way to jump. As Shelton, director of performance and organization development, explains:

"18 months ago in mid 2003, Central Norfolk's economy was a system in trouble. Morale was very low. There was a sense of immediate crisis combined with apathy and a feeling of helplessness in knowing how to respond.

"The economy was facing an £18 million deficit – and this was rising. National performance targets were being missed including within the acute hospital which by the winter of 2003 had one of the largest number of waiting time in-patient breaches in England and was the subject of a lot of intense scrutiny.

"Confidence was at an all-time low, among internal staff and externally. The good news was that the chief executives recognized this and that carrying on doing more of the same was not going to lead to long term sustainable recovery."

Shelton's remit for change, set in the summer of 2003, was to "shake the tree" and deliver a plan to hit all the NHS targets and deliver a sustainable financial recovery. "I did not believe that the more traditional approach of cutting services to save money was the long term solution. Sustainable improvement was only going to be achieved through focused organizational development and a new way to empower and motivate staff, who would be driven to improve performance which in turn would lead to financial recovery."

The muscle she drew on to help 'shake the tree' came from a very unorthodox source. Afterburner Healthcare, the company brought in to deliver the organizational development programme, was founded by former US fighter pilots advocating planning, review and continuous improvement techniques based on methods used by fighter pilots since the 1950s and during rapid deployment operations in the Gulf and Balkan Wars of the 1990s.

The idea of US military strike specialists teaching NHS managers and clinicians how to plan and improve the delivery of state healthcare services seems incongruous. But this incongruity was a pre-meditated part of Shelton's change strategy.

"It was a conscious break with motherhood," she says. "Changing the language and the way we did things provided the catalyst for the change we wanted to achieve. The Afterburner fighter pilot imperative was symbolic. It challenged the status quo and sent out a loud message to everybody that things are different now."

Like all radical ideas, the programme was born out of serendipity. Shelton was attending a US healthcare conference looking for lessons she could learn to help fulfil her remit and met the director of Afterburner Healthcare in a lift. Even he looked askance at the notion and needed a lot of persuasion from Shelton.

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